Transanal irrigation improves quality of life in patients with low anterior resection syndrome

Rosén, Harald; Robert‐Yap, Joan; Tentschert, G; Lechner, Michaela; Roche, Bruno

doi:10.1111/j.1463-1318.2011.02692.x

Cited by 78 publications

(62 citation statements)

References 20 publications

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“…13,14 the effect of the irrigation administration is in part due to a simple mechanical wash-out effect, but studies of enema administration through colostomies have shown that irrigation with an enema above 250 ml generates colonic mass movements and other colonic functional responses, suggesting that a regular management of bowel function through irrigation could have a rehabilitative effect on colonic motility.…”

Section: Treatment Algorithmmentioning

confidence: 98%

Low Anterior Resection Syndrome

Martellucci

2016

Diseases of the Colon &Amp; Rectum

124

112

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f or almost 100 years abdominoperineal excision has been the standard treatment of choice for rectal cancer. however, as miles said, "the operation is a severe one. i do not think that it should be performed on those over 60 years of age; of 10 such cases all died. With regard to the remainder, of whom there were 36, 8 died from the effects of the operation, 4 have had recurrence, 2 died of intercurrent disease, while 22 are alive and well after periods varying from six months to six years." 1 the conviction that the quality of life for patients with a colostomy after abdominoperineal excision was poorer than for patients undergoing an operation with a sphincterpreserving technique has meant that, over the past 20 years, the anterior resection with preservation of the sphincter function has become the preferred treatment for rectal cancers, with the exception of those cancers very close to the anal sphincter.to date, also thanks to the multimodal treatment of rectal cancer, sphincter-preserving surgery with the restoration of bowel continuity to avoid a permanent colostomy is feasible in up to 80% of these patients. however, patients having sphincter-preserving operations may experience symptoms affecting their quality of life that are different from stoma patients and the question of whether the quality of life of people after anterior resection is superior to that of people after abdominoperineal excision/hartmann operation has yet to be answered.in fact, up to 80% of patients undergoing a low or very low anterior resection will experience postoperatively a constellation of symptoms including fecal urgency, frequent bowel movements, bowel fragmentation, emptying difficulties and incontinence, increased gas, collectively referred to as the low anterior resection syndrome (laRs).even if most of the functional impairments are clinically recovered by 6 to 12 months after the operation, longterm studies are now reporting the presence of adverse symptoms up to 15 years after resection. these long-term results suggest that after about 12 months, the symptoms of anterior resection syndrome are the result of permanent changes rather than short-lived neorectal irritability in the postoperative period. 2 Bowel dysfunction is a major problem with an immense impact on quality of life following sphincter-preserving resection, and the quality of life of patients who have had rectal cancer is closely associated with the severity of the laRs. 3 impaired bowel function is usually provoked by the variable association of colonic dysmotility, neorectal reservoir dysfunction, and anal sphincter or pelvic nerves damage.there are currently no specific treatments for anterior resection syndrome. management is empirical and symptom based, using existing therapies for fecal incontinence, fecal urgency, and rectal evacuatory disorders. moreover, rectal cancer specialists do not have a very thorough understanding of which bowel dysfunction symptoms truly matter to the patient after sphincter-preserving treatment, or how these symptoms affe...

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Section: Treatment Algorithmmentioning

confidence: 98%

Low Anterior Resection Syndrome

Martellucci

2016

Diseases of the Colon &Amp; Rectum

124

112

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“…13 TAI can improve both faecal incontinence and defecation disorders in this group. [14][15][16] Moreover, resectional and ileo-anal pouch surgery may cause functional problems, and efficacy of TAI in this patient group has been shown too, with specifically enhanced ability to cope with the long-term consequences of surgery. 17 The effect of TAI varies considerably between patients: some report full satisfaction and great improvements in their quality of life, whereas others experience poor or no efficacy and abandon treatment.…”

Section: Introductionmentioning

confidence: 99%

Consensus review of best practice of transanal irrigation in adults

et al. 2013

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Study design: Review article. Objectives: To provide a consensus expert review of the treatment modality for transanal irrigation (TAI). Methods: A consensus group of specialists from a range of nations and disciplines who have experience in prescribing and monitoring patients using TAI worked together assimilating both the emerging literature and rapidly accruing clinical expertise. Consensus was reached by a round table discussion process, with individual members leading the article write-up in the sections where they had particular expertise. Results: Detailed trouble-shooting tips and an algorithm of care to assist professionals with patient selection, management and follow-up was developed. Conclusion: This expert review provides a practical adjunct to training for the emerging therapeutic area of TAI. Careful patient selection, directly supervised training and sustained follow-up are key to optimise outcomes with the technique. Adopting a tailored, stepped approach to care is important in the heterogeneous patient groups to whom TAI may be applied. Sponsorship: The review was financially supported by Coloplast A/S.

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“…Based on previously reported experiences [10], TAI will be performed with the Peristeen ® system (Coloplast A/S, Humblebaek, Denmark); however, in patients with difficulties in introducing the irrigator due to stenosis of the anastomosis, application of a large (28 French) Foley catheter will be accepted, which can be flushed by using 100-ml syringes.…”

Section: Transanal Irrigationmentioning

confidence: 99%

“…Dietary approaches including a fiberrich diet and constipating agents as well as pelvic floor muscle training are still regarded as the first-line therapyalthough scientific evidence of their effect in LARS is lacking and their efficacy in this special subset of patients must be questioned [10,11].…”

Section: Introductionmentioning

confidence: 99%

“…Transanal irrigation (TAI) was described as an effective approach for functional problems following rectal resection as early as 1989 [13]; however, TAI failed to get broader attention in the surgical community and it was only until the new millennium that different European study groups "reinvented" this treatment for severe LARS in the followup of patients after rectal resection [10,11,14].…”

Section: Introductionmentioning

confidence: 99%

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